title: Delayed-onset complications of facial soft tissue augmentation with permanent fillers in 85 patients.
abstract: OBJECTIVE
  To evaluate factors influencing the onset and type of adverse events in patients injected with permanent fillers in the face and to propose a therapeutic strategy for these complications.
  
  
  METHODS
  A prospectively attained series of 85 patients with delayed-onset complications after facial injection with permanent fillers underwent clinical follow-up and treatment of the complications.
  
  
  RESULTS
  Lag times until onset and type of delayed-onset complication varied according to filler material. In 28% (n = 24) of the cases, patients reported the onset of complications after dental procedures, additional injections with fillers, or other invasive treatments in the facial area. Forty-eight (57%) patients required invasive treatment. Abscess formation was significantly more frequent in patients with human immunodeficiency virus infection and facial lipoatrophy (p = .001).
  
  
  CONCLUSIONS
  The intrinsic characteristics of the injected filler and the immune status of the patient play important roles in the diversity of time of onset and type of delayed-onset adverse events observed. It seems that invasive facial or oral procedures in the vicinity of filler depots can provoke such complications. We propose a strategy for treating these complications and advise great caution when using permanent filling agents.
authors.affiliation: Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Kadouch
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kadouch
authors.forename: Shai
authors.initials: S
authors.lastname: Fortuin
authors.forename: Leo
authors.initials: L
authors.lastname: van Rozelaar
authors.forename: Refaat B
authors.initials: RB
authors.lastname: Karim
authors.forename: Rick
authors.initials: R
authors.lastname: Hoekzema
mesh_terms: D000038:Abscess / Q000139:chemically induced* / Q000382:microbiology / Q000601:surgery; D000179:Acrylates / Q000009:adverse effects; D000180:Acrylic Resins / Q000009:adverse effects; D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D001284:Atrophy / Q000139:chemically induced / Q000188:drug therapy; D003094:Collagen / Q000009:adverse effects; D003357:Cosmetic Techniques / Q000009:adverse effects*; D004129:Dimethylpolysiloxanes / Q000009:adverse effects; D005145:Face; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects; D020100:Hydrogels / Q000009:adverse effects; D007249:Inflammation / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000009:adverse effects; D011446:Prospective Studies; D012060:Rejuvenation; D013997:Time Factors
chemical_list: D000179:Acrylates; D000180:Acrylic Resins; D044966:Anti-Retroviral Agents; C486838:Aquamid; C445359:Artecoll; C470344:Bio-Alcamid; C482306:Dermalive; D004129:Dimethylpolysiloxanes; D020100:Hydrogels; C013830:baysilon; D006820:Hyaluronic Acid; D003094:Collagen; D019904:Polymethyl Methacrylate